Journal articles on the topic 'Psychiatric consultation Australia'
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1
Looi, Jeffrey CL, Stephen Allison, Tarun Bastiampillai, and William Pring. "Private practice metropolitan telepsychiatry in smaller Australian jurisdictions during the COVID-19 pandemic: preliminary analysis of the introduction of new Medicare Benefits Schedule items." Australasian Psychiatry 28, no. 6 (October 5, 2020): 639–43. http://dx.doi.org/10.1177/1039856220960381.
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Objective: To analyse the smaller Australian state/territory service impact of the introduction of new COVID-19 psychiatrist video and telephone telehealth Medicare Benefits Schedule (MBS) items. Method: MBS item service data were extracted for COVID-19 psychiatrist video and telephone telehealth item numbers corresponding to the pre-existing in-person consultations for the Australian Capital Territory (ACT), Northern Territory (NT), South Australia (SA) and Tasmania. Results: The overall rate of consultations (face-to-face and telehealth) increased during March and April 2020, compared to the monthly face-to-face consultation average, excepting Tasmania. Compared to an annual monthly average of in-person consultations for July 2018–June 2019, total telepsychiatry consultations were higher for April than May. For total video and telephone telehealth consultations combined, video consultations were lower in April and higher in May. As a percentage of combined telehealth and in-person consultations, telehealth was greater for April and lower for May compared to the monthly face-to-face consultation average. Conclusions: In the smaller states/territories, the private practice workforce rapidly adopted COVID-19 MBS telehealth items, with the majority of psychiatric consultation shifting to telehealth initially, and then returning to face-to-face. With a second wave of COVID-19 in Australia, telehealth is likely to remain a vital part of the national mental health strategy.
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Smith, Graeme C. "The Future of Consultation–Liaison Psychiatry." Australian & New Zealand Journal of Psychiatry 37, no. 2 (April 2003): 150–59. http://dx.doi.org/10.1046/j.1440-1614.2003.01136.x.
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Objective: To review the status of consultation–liaison psychiatry and the factors shaping it, and suggest strategies for its future development. Method: In addition to searches of the main computerized psychiatric databases and review of relevant Commonwealth of Australia publications, the author drew on discussions with national and international colleagues in his role as convenor of the International Organization for Consultation–Liaison Psychiatry. Results: Physical/psychiatric comorbidity and somatization, the conditions in which consultation–liaison psychiatry specializes, are the commonest forms of psychiatric presentation in the community. They are as disabling as psychotic disorders, and comorbid depression in particular is a predictor of increased morbidity and mortality. Acknowledging this, the Second Australian National Mental Health Plan called for consultation–liaison psychiatry to be allowed to participate fully in the mental health care system. It stated that failure to define the term ‘severe mental health problems and mental disorders’ in the First Plan had led to some public mental health systems erroneously equating severity with diagnosis rather than level of need and disability. The call has been largely unheeded. The implication for patient care is both direct and indirect; the context created for psychiatry training by such a restricted focus is helping to perpetuate the neglect of such patients. This is a worldwide problem. Conclusions: Proactive involvement with consumers is required if the problem is to be redressed. At a service level, development of a seamless web of pre-admission/admission/post-discharge functions is required if patients with physical/psychiatric comorbidity and somatoform disorders are to receive effective care, and consultation–liaison psychiatry services are to be able to demonstrate efficacy. Focus on comorbidity in the Australian Third National Mental Health Plan may force resolution of the current problems.
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Looi, Jeffrey C. L., Stephen Allison, Stephen R. Kisely, William Pring, Rebecca E. Reay, and Tarun Bastiampillai. "Greatly increased Victorian outpatient private psychiatric care during the COVID-19 pandemic: new MBS-telehealth-item and face-to-face psychiatrist office-based services from April–September 2020." Australasian Psychiatry 29, no. 4 (April 13, 2021): 423–29. http://dx.doi.org/10.1177/10398562211006133.
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Objective: The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists’ uptake of telehealth, and face-to-face consultations for April–September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019. Method: MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April–September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia. Results: Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April–September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria’s increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April–September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April–September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations. Conclusions: During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019.
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Bidargaddi, Niranjan, Geoffrey Schrader, David Smith, Dean Carson, and Jörg Strobel. "Characteristics of patients seen by visiting psychiatrists through Medicare in a rural community mental health service with an established telemedicine service." Australasian Psychiatry 25, no. 3 (February 7, 2017): 266–69. http://dx.doi.org/10.1177/1039856216689527.
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Objective: We aimed to determine characteristics of patients receiving Medicare-funded face-to-face consultations by psychiatrists in a rural service with an established telemedicine service. Methods: For this study, 55 case-managed patients from four rural community mental health teams in South Australia provided information through questionnaires regarding psychological symptoms, quality of life, body mass index (BMI) and gave access to their Medicare data. Results: In a logistic regression, it was found that being younger was more likely associated with a Medicare psychiatric consultation ( p<0.05). Participants with at least one recorded visit to a Medicare psychiatrist consultation also tended to have lower levels of psychological distress at the end of the 4-year period, have a higher BMI, and more general practitioner consultations. Conclusion: The study provides clinicians and policy makers with preliminary information on the subtle differences in clinical profile of patients seen by Medicare-funded psychiatrists within an established state-managed telepsychiatry service.
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Looi, Jeffrey CL, Stephen Allison, Tarun Bastiampillai, William Pring, and Stephen R. Kisely. "Telepsychiatry and face-to-face psychiatric consultations during the first year of the COVID-19 pandemic in Australia: patients being heard and seen." Australasian Psychiatry 30, no. 2 (November 23, 2021): 206–11. http://dx.doi.org/10.1177/10398562211046301.
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Objective: The Australian federal government introduced additional Medicare Benefits Schedule (MBS) telehealth-items to facilitate care by private psychiatrists during the COVID-19 pandemic. Method: We analysed private psychiatrists’ uptake of video and telephone-telehealth, as well as total (telehealth and face-to-face) consultations for April 2020–April 2021. We compare these to face-to-face consultations for April 2018–April 2019. MBS-Item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with face-to-face consultations for the whole of Australia. Results: Psychiatric consultation numbers (telehealth and face-to-face) were 13% higher during the first year of the pandemic compared with 2018–2019, with telehealth accounting for 40% of this total. Face-to-face consultations were 65% of the comparative number of 2018–2019 consultations. There was substantial usage of telehealth consultations during 2020–2021. The majority of telehealth involved short telephone consultations of ⩽15–30 min, while video was used more, in longer consultations. Conclusions: Private psychiatrists and patients continued using the new telehealth-items during 2020–2021. This compensated for decreases in face-to-face consultations and resulted in an overall increase in the total patient contacts compared to 2018–2019.
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Cammell, Paul. "Emergency psychiatry: a product of circumstance or a growing sub-speciality field?" Australasian Psychiatry 25, no. 1 (September 26, 2016): 53–55. http://dx.doi.org/10.1177/1039856216665286.
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Objectives: This article reviews recent trends in the provision of psychiatric services to the emergency departments of tertiary hospitals in Australia, involving the establishment of specialised in-reach or liaison services as well as various forms of short stay unit attached to emergency departments. The Emergency Psychiatry Service at Flinders Medical Centre, South Australia, is described as a case example. Its specialised models of assessment and clinical care are described, highlighting how these are differentiated from more traditional models in inpatient, community and general hospital consultation–liaison psychiatry. Conclusions: Emergency psychiatry, and in particular the application of specialised psychiatric models of in-reach service and short stay units, is an increasingly important and growing field of psychiatry that warrants further exploration in research. The Emergency Psychiatry Service at Flinders Medical Centre has developed a distinct group of assessment and treatment approaches that exemplifies this growing field.
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Carr, Vaughan J., Terry J. Lewin, Jane M. Walton, Catherine Faehrmann, and Alexander L. A. Reid. "Consultation—Liaison Psychiatry in General Practice." Australian & New Zealand Journal of Psychiatry 31, no. 1 (February 1997): 85–94. http://dx.doi.org/10.3109/00048679709073804.
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Objective:This paper describes the characteristics of 303 consecutive referrals, over a 12-month period, to a consultation—liaison (C—L) psychiatry service provided to eight group general practices in Newcastle, Australia. Method:A purpose designed service audit form was used throughout the evaluation period to collect information about demographic characteristics, reasons for referral, service contacts, psychiatric diagnoses and clinical management. In addition, patients were invited to participate in a separate, prospective outcome evaluation study, which involved structured interviews and questionnaires. Results:The most common reasons for referral were: depression (33%); anxiety (12%); diagnostic assessment (9%); and impaired relationships (8%). The most common psychiatric diagnoses were: mood disorders (29%); mild, transient conditions (29%); anxiety (14%); and substance abuse disorders (12%). Following the psychiatric consultation(s), GPs were actively involved in patients’ treatment in 53% of cases. However, there was a higher than expected rate of referral (44%) to another mental health agency. Selected comparisons are also reported between patients referred to the C—L service (n = 303) and a sample of non-referred GP attenders (n = 535). Conclusions:As expected, the diagnostic profiles of patients attending the C—L service differed in several respects from those using similar services in general hospitals. There were comparatively low rates of organic brain syndromes, suicide risk evaluations, and problems of differential diagnosis of somatic symptoms. Greater emphasis needs to be placed on more formal psychiatric education for GPs, on ways of screening out from the referral process those patients with mild, transient conditions who do not require specialist expertise, and on the development of strategies to help GPs manage such conditions.
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Paterson, Tom, Christopher Seiboth, Barbara Magin, Rajan Nagesh, Cyndy Lloyd, and Helena Williams. "An initiative in primary care psychiatry in South Australia." Australasian Psychiatry 10, no. 3 (September 2002): 259–64. http://dx.doi.org/10.1177/103985620201000313.
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Objective: To describe a joint mental health project involving the Adelaide Northern Division of General Practice (ANDGP) and the North West Adelaide Mental Health Service (NWAMHS). Conclusions: This project has been developed to explore alternative strategies to facilitate the identification and management of patients with mental illness in the primary care setting. The project has also endeavoured to explore alternative types of psychiatrist/general practitioner interactions other than the conventional ‘general practitioner referred psychiatrist consultation’. The development of adequate and clinically relevant evaluation methods, both quantitative and qualitative, has also been an explicit objective of the project. While the project provides an exciting stimulus for ongoing development of models of Primary Psychiatric Care, it is evident that such models can only evolve in the context of significant service and systemic change. It is hoped that the experiences in the northern suburbs of Adelaide can stimulate others to explore the ongoing collaborations between psychiatric services and general practitioners in ways that can produce better mental health outcomes in our patients.
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Looi, Jeffrey CL, Stephen Allison, Tarun Bastiampillai, William Pring, Rebecca Reay, and Stephen R. Kisely. "Increased Australian outpatient private practice psychiatric care during the COVID-19 pandemic: usage of new MBS-telehealth item and face-to-face psychiatrist office-based services in Quarter 3, 2020." Australasian Psychiatry 29, no. 2 (February 24, 2021): 194–99. http://dx.doi.org/10.1177/1039856221992634.
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Objective: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists’ uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July–September), 2020. We compare these to the same quarter in 2019. Method: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July–September), 2019, of face-to-face consultations for the whole of Australia. Results: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15–30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations. Conclusions: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.
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Kissane, David W., and Graeme C. Smith. "Consultation-Liaison Psychiatry in an Australian Oncology Unit." Australian & New Zealand Journal of Psychiatry 30, no. 3 (June 1996): 397–404. http://dx.doi.org/10.3109/00048679609065005.
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Objective: To provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an oncology unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database. Method: The MICROCARES prospective clinical database system was used to record data on all oncology inpatients referred to C-L psychiatry, and the hospital clinical database was used to compare referred inpatients with all oncology inpatients. Results: Two hundred and seventy-one referrals were made in the 3 years from 1991 to 1993, a referral rate of 10.4%. The referred patients were younger but there was no bias in sex and marital status. The mean length of stay was twice that for all other oncology admissions, day cases excluded. The most frequent reasons for referral were coping problems, depression, terminal illness issues and anxiety. The most common psychiatric diagnoses were Systemic Family Problems (V codes, 24%), Mood Disorders (23%), Adjustment Disorders (16%) and Organic Mental Disorders (10%). Management involved family conferences in half of the patients and antidepressant medication in one-quarter. Concordance with pharmacological recommendations was 98%. Existential issues and family-centred care are discussed. Conclusions: Both individual and family-centred care is required in an oncology service; a dedicated liaison attachment offers considerable staff support. Psycho-oncology is underdeveloped in Australia compared to many overseas services; there is scope for substantial growth in preventive and supportive work.
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Sved Williams, Anne, and Jill Poulton. "Supporting Mental Health in the Community: New Systems for General Practice." Australian Journal of Primary Health 12, no. 2 (2006): 105. http://dx.doi.org/10.1071/py06029.
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General practitioners (GPs) manage nearly one-third of Australians seeking help for mental health problems, and frequently express their need for consultant psychiatric support in this work. The introduction of new Medical Benefits Schedule Item Numbers 291 and 293 to provide "one-off" psychiatric assessments on referral from GPs offered the potential for providing this support, and a single point-of-entry scheme was organised to provide ease of access to appointments. The aims were to establish a single point of entry for psychiatrist assessment using Item 291, to evaluate the take-up rates of Item 291 in South Australia (SA) through this service and to evaluate the acceptability to GPs and psychiatrists of a psychiatric primary care consultation-liaison (c-l) model. Results were: 26 psychiatrists joined the project; 64 GPs referred 78 patients for assessment, providing 24% of the Australian take-up rate for Item 291, for 8% of the population; evaluation showed high approval ratings from GPs who particularly appreciated the single contact point; and positive evaluation by psychiatrists of the primary care c-l model. The conclusions were that a single contact point provided ease of access to psychiatrists for GPs; GP and psychiatrist groups evaluated Item 291 very positively; and consumer and carer evaluation are essential for further primary care c-l development.
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Chambers, Georgina M., Sean Randall, Cathrine Mihalopoulos, Nicole Reilly, Elizabeth A. Sullivan, Nicole Highet, Vera A. Morgan, Maxine L. Croft, Mary Lou Chatterton, and Marie-Paule Austin. "Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia." Australian Health Review 42, no. 5 (2018): 514. http://dx.doi.org/10.1071/ah17118.
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Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients’ costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011–12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29 million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.
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Adegbite, Adebola, and George Howson. "The Effect of the First Coronavirus Lockdown on Psychiatric Outpatient Attendance, a North Fife Survey." BJPsych Open 8, S1 (June 2022): S147—S148. http://dx.doi.org/10.1192/bjo.2022.422.
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AimsThere has been a significant change in the way we see patients during psychiatric consultations, this has led to challenges we face in delivering safe and effective care to patients under our care. “Telepsychiatry” has been used in literature from countries like Australia and India, there is very little around coming from the UK but there appears to be many ongoing research making the rounds. It is interesting to know that the existing literature on remote/virtual consultations during the COVID-19 pandemic are on the rise. The idea of this study was conceived during outpatient clinics after making an observation that many patients were likely to miss their appointments when they had telephone appointments compared to video consultations. This prompted a study to know if this is more likely to be observed in other outpatient clinics. The purpose of this study was to establish if virtual/remote consulting has affected patient attendance rate and whether this is also affected by the type of virtual consultation.MethodsThe data were collected using the “2020 stats sheets” for inpatient appointments between North Fife consultants from January to October 2020. This was registered with the NHS Fife clinical effectiveness team in January 2021.ResultsThe results were categorized for the purpose of this survey as January – March (Pre-lockdown) and April – October (lockdown). It is important to note that some face-to-face appointments occurred during lockdown because there were emergency assessments and drug monitoring appointments scheduled.The results of this survey showed that there was a clear reduction in clinic appointments made during lockdown compared to pre-lockdown and slight observable improvement in attendance rates during the lockdown. There was no statistical significance seen using t-test comparing attendance rates between video and telephone consultations including new patient virtual consultations.ConclusionThe large sample size over this period suggests that the results are reliable and valid, we can therefore say virtual/telephone consultation does not affect attendance. It should be noted that the attendance rate may be a good indicator but we should also consider patient/clinician satisfaction, communication quality/effectiveness and other factors which could influence patient's compliance to outpatient follow-up. It is important to acknowledge the lack of a control group and the COVID-19 pandemic were major cofounding factors. Mental health services should continue the use of virtual consultation post-pandemic and possibly integrate it with in person consultations (hybrid), this may help with attendance rate of patients with difficulty attending face-to-face appointments.
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Clarke, P. H. J. "A referrer and patient evaluation of a telepsychiatry consultation–liaison service in South Australia." Journal of Telemedicine and Telecare 3, no. 1_suppl (June 1997): 12–14. http://dx.doi.org/10.1258/1357633971930788.
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A study was carried out to describe the patient population assessed by a telepsychiatry consultation-liaison service in rural South Australia, and to assess the referrers’ and patients’ satisfaction rating with this service. The study was performed in two parts, with retrospective and prospective components. The author completed a semi-structured interview for each patient (n=75) with a Brief Psychiatric Rating Scale (BPRS) for the prospective group (n=32). A questionnaire was also sent to all referrers seeking an evaluation of the usefulness of the telepsychiatry interview in terms of assessment and management recommendations and outcome. Patients from the prospective group were sent a questionnaire examining their evaluation of the usefulness of the interview in terms of assessment and management recommendations, and difficulties with the technology. The patient population was characterized by high rates of affective disorder and personality disorder, and high indices of developmental disturbance. Referrers reported high rates of satisfaction with the service. Nursing staff rated the service more positively than general practitioners. The usefulness for assessment was rated more highly than for management.
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Looi, Jeffrey CL, Stephen Allison, Tarun Bastiampillai, and William Pring. "Private practice metropolitan telepsychiatry in larger Australian states during the COVID-19 pandemic: an analysis of the first 2 months of new MBS telehealth item psychiatrist services." Australasian Psychiatry 28, no. 6 (September 30, 2020): 644–48. http://dx.doi.org/10.1177/1039856220961906.
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Objective: Private practice psychiatry in Australia was largely office-based until the Commonwealth Government introduced new psychiatrist Medicare Benefits Schedule (MBS) telehealth items in response to the first wave of the COVID-19 pandemic. We investigate the uptake of (1) video and telephone telehealth consultations in April–May 2020, and (2) the overall changing rates of consultation, i.e. total telehealth and in-person consultations across the larger states of Australia. Method: MBS item service data were extracted for COVID-19 psychiatrist video- and telephone-telehealth item numbers and compared with a baseline of the 2018−2019-financial-year monthly average of in-person consultations for New South Wales, Queensland, Victoria, and Western Australia. Results: Total psychiatry consultations (telehealth and in-person) rose during the first wave of the pandemic by 10%−20% compared to the previous year. The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Most telehealth provision was by telephone for short consultations of ⩽15−30 min. Video consultations increased from April into May. Conclusions: For large states, there has been a rapid adoption of the MBS telehealth psychiatrist items, followed by a trend back to face-to-face as COVID-19 new case rates reduced. There was an overall increased consultation rate (in-person plus telehealth) for April−May 2020.
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D'souza, Russell. "A pilot study of an educational service for rural mental health practitioners in South Australia using telemedicine." Journal of Telemedicine and Telecare 6, no. 1_suppl (February 2000): 187–89. http://dx.doi.org/10.1258/1357633001934627.
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Studies have found that rural patients want to be treated in their local hospitals. However, there have been difficulties with recruiting and retaining professionals in rural areas of Australia. Isolation, lack of professional development programmes, lack of academic programmes, lack of peer consultation and the need to travel long distances are some of the reasons identified in the National Rural Health strategy. A pilot service of educational programmes delivered by telemedicine was initiated and then evaluated. Forty-six community mental health workers from nine rural areas and 20 general practitioners from five rural areas participated. High satisfaction with the use of telemedicine was recorded by both groups. Telemedicine reduced the disincentives to rural practice, and also improved the professionals’ competence and confidence in managing patients with psychiatric illness.
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Meadows, Graham, Bruce Singh, Philip Burgess, and Irene Bobevski. "Psychiatry and the Need for Mental Health Care in Australia: Findings from the National Survey of Mental Health and Wellbeing." Australian & New Zealand Journal of Psychiatry 36, no. 2 (April 2002): 210–16. http://dx.doi.org/10.1046/j.1440-1614.2002.00990.x.
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Objective: This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists, and describes the meeting of perceived needs for mental health care within those seen by psychiatrists. Method: The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care. Results: By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist. Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization. This effect is stronger in psychiatry than in other specialities. Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction. Conclusions: Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner, and the inequalities are greater for psychiatric services than for other medical specialities.
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Mendizabal, Adys, Jennifer M. Diaz, Arturo V. Bustamante, and Yvette Bordelon. "Health Services in Huntington Disease." Neurology: Clinical Practice 13, no. 1 (January 11, 2023): e200108. http://dx.doi.org/10.1212/cpj.0000000000200108.
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Purpose of ReviewClinical trials for Huntington disease (HD) have primarily focused on managing chorea and, more recently, the development of disease-modifying therapies (DMTs). Nonetheless, understanding health services among patients with HD is essential for assessing new therapeutics, development of quality metrics, and overall quality of life of patients and families with HD. Health services assess health care utilization patterns, outcomes, and health care–associated costs, which can help shape the development of therapeutics and aid in policies that affect patients with a specific condition. In this systematic literature review, we analyze data of published studies looking at causes of hospitalization, outcomes, and health care costs in HD.Recent FindingsThe search yielded 8 articles published in the English language and comprising data from the United States, Australia, New Zealand, and Israel. The most common cause of hospitalization among patients with HD was dysphagia or dysphagia-related complications (e.g., aspiration pneumonia or malnutrition), followed by psychiatric or behavioral symptoms. Patients with HD had more prolonged hospitalizations than non-HD patients, and it was most prominent among those with advanced disease. Patients with HD were more likely to be discharged to a facility. A small percentage received inpatient palliative care consultation, and behavioral symptoms were a primary cause of discharge to another facility. Interventions such as gastrostomy tube placement had associated morbidity, and it was common among patients with HD with a diagnosis of dementia. Palliative care consultation and specialized nursing care were associated with more routine discharges and fewer hospitalizations. In terms of cost, patients with HD with private and public insurances had the highest expenditure with more advanced disease, and expenses were associated with hospitalization and medication costs.SummaryIn addition to DMTs, HD clinical trial development should also consider the leading causes of hospitalization, morbidity, and mortality in patients with HD, including dysphagia and psychiatric disease. No research study, to our knowledge, has systematically reviewed health services research studies in HD. Evidence from health services research is needed to evaluate the efficacy of pharmacologic and supportive therapies. This type of research is also critical in understanding health care costs associated with the disease and to better advocate and shape policies that can benefit this patient population.
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Draper, Brian M., and Annette Koschera. "Do Older People Receive Equitable Private Psychiatric Service Provision Under Medicare?" Australian & New Zealand Journal of Psychiatry 35, no. 5 (October 2001): 626–30. http://dx.doi.org/10.1080/0004867010060511.
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Objective: The objective of this study is to determine the 1998 rates, types, regional variation and Medicare expenditure of private psychiatry services for older people in Australia, as compared with younger adults and with 1985–1986 data. Method: Medicare Benefits Schedule Item Statistics for the psychiatric item numbers 300–352 and item 14224 were obtained from the Health Insurance Commission for each State and Territory. The items were examined in the age groups 15–64 years, 65 years and over and 75 years and over. Main outcome measures were per capita service provision by age group, State and Territory and Medicare expenditure by age group. Results: During 1998, 6.4% (5765.6 per 100 000) of private psychiatric services were to patients aged > 64 years. Patients aged 15–64 received 2.7 times the number of psychiatric services per capita than patients > 64 and 3.6 times that of patients aged > 74 years. Patients aged > 64 received more hospital and nursing home consultations, home visits and electroconvulsive therapy per capita, while younger adults used more office-based consultations, longer consultations, and group therapy. Victoria had the highest per capita rate (7659.2 per 100 000) and the Northern Territory the lowest (540.4 per 100 000), although the highest proportion of services to older patients was in Western Australia. Per capita the proportion of Medicare expenditure allocated to adults aged less than 65 years was 4.1 times that for adults over 64 years. Conclusions: Private psychiatric service provision to older people is inequitable when compared with younger adults. The proportion of Medicare private psychiatry expenditure on older adults has declined since 1985–1986.
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Couper, Jeremy. "Chronic Fatigue Syndrome and Australian Psychiatry: Lessons from the UK Experience." Australian & New Zealand Journal of Psychiatry 34, no. 5 (October 2000): 762–69. http://dx.doi.org/10.1080/j.1440-1614.2000.00810.x.
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Objective: The aim of this paper is to outline the opportunities and dangers the chronic fatigue syndrome (CFS) issue presents to Australian psychiatry. Method: The scientific literature of the last 50 years on CFS in adults was reviewed and samples of recent media portrayals of CFS in the UK and Australia were collected. The author has worked in both the UK and Australia managing adult CFS patients in specialist outpatient consultation–liaison (C–L) psychiatry settings. Results: Chronic fatigue syndrome has been at the heart of an acrimonious debate in the UK, both within the medical profession and in the wider community. UK psychiatry has been drawn into the debate, at times being the target of strong and potentially damaging criticism, yet UK psychiatry, especially the C–L subspecialty, has played a crucial role in clarifying appropriate research questions and in devising management strategies. The issue has served to enhance and broaden psychiatry's perceived research and clinical role at the important medicine–psychiatry interface in that country. Conclusions: Handled properly, the CFS issue offers Australian psychiatry, especially C–L psychiatry, an opportunity to make a useful contribution to patient care in a clinically difficult and contentious area, while at the same time serving to help broaden psychiatry's scope in the Australian medical landscape.
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Wade, Victoria, Jeffrey Soar, and Len Gray. "Uptake of telehealth services funded by Medicare in Australia." Australian Health Review 38, no. 5 (2014): 528. http://dx.doi.org/10.1071/ah14090.
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Objective The aim of this study is to identify the extent to which the Medicare item numbers and incentives, introduced in July 2011, have been effective in stimulating telehealth activity in Australia. Methods A retrospective descriptive study utilising data on the uptake of telehealth item numbers and associated in-person services, from July 2011 to April 2014, were obtained from Medicare Australia. The main outcome measures were number of telehealth services over time, plus uptake proportionate to in-person services, by jurisdiction, by speciality, and by patient gender. Results Specialist consultations delivered by video communication and rebated by Medicare rose to 6000 per month, which is 0.24% of the total number of specialist consultations. The highest proportional uptake was in geriatrics and psychiatry. In 52% per cent of video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. There were substantial jurisdictional differences. A significantly lower percentage of female patients were rebated for item 99, which is primarily used by surgeons. Conclusions Medicare rebates and incentives, which are generous by world standards, have resulted in specialist video consultations being provided to underserved areas, although gaps still remain that need new models of care to be developed. What is known about the topic? Video consultations have been rebated by Medicare since July 2011 as a means of increasing access to specialist care in rural areas, aged care facilities and Aboriginal health services. What does this paper add? The uptake of this telehealth initiative has grown over time, but still remains low. For half the video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. Geriatrics and psychiatry are the specialties with the highest proportional uptake. What are the implications for practitioners? New models of care with a greater focus on consultation-liaison with primary care providers need to be developed to realise the potential of this initiative and to fill continuing gaps in services.
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Wand, Anne P. F., and James George. "Observations of a traveling fellow: consultation–liaison psychiatry versus joint units for delirium management." International Psychogeriatrics 25, no. 7 (February 21, 2013): 1204–6. http://dx.doi.org/10.1017/s1041610213000124.
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There are various approaches to providing specialist care for patients with delirium in general hospitals. Those described in the literature include joint geriatric/psychiatric units and consultation–liaison (CL) psychiatry services. The Ferdinande Johanna Kanjilal Travelling Fellowship, from the Royal College of Psychiatrists, UK, provided an opportunity to more fully understand each model. This letter outlines observations of the Australian Fellow (AW) of different service structures in the care of hospitalized older people with delirium in the United Kingdom and Ireland.
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Atmore, Katie, Louise Howard, and Abigail Easter. "Preconception interventions and resources for women with serious mental illness: a rapid evidence review." BJPsych Open 7, S1 (June 2021): S234. http://dx.doi.org/10.1192/bjo.2021.626.
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AimsThere is little research into evidence-based preconception interventions for women with serious mental illness (SMI). Women with SMI will have specific needs around preconception due to the complexities of the teratogenicity of medications, risk of mental illness relapse and higher levels of stigma around motherhood. If effectively delivered preconception care could mitigate these difficulties and improve outcomes for mother and baby. The aim of this research was therefore to determine to identify and describe studies evaluating preconception interventions for women of child-bearing age who have an existing SMI through searches of the peer-reviewed literature.MethodA rapid review was conducted to search MEDLINE and PsychINFO databases from the year 2000 onwards for peer-reviewed articles describing preconception interventions/resources delivered prior to a pregnancy to women of child-bearing age with a pre-existing existing serious mental illness (including schizophrenia, bipolar and eating disorders).ResultA total of 592 results were returned from the searches and 576 of these remained after the removal of duplicates. 11 studies were included in the final narrative synthesis describing the following intervention types: Health warning (1), Health screening (1), Teratogen phone service (2), Psychiatric consultation (5), Family planning information (1) and Peripartum management plan (1). Interventions were delivered in Australia, UK, Italy, Germany, Netherlands, USA and Nigeria.ConclusionThough the included studies indicated that some efforts have been made globally to meet the preconception needs of women with SMI the numbers included in the studies tended to be low and reflective of small-scale service provision. Future studies utilising a randomised controlled trial design would lower the risk of bias and provide more generalisable evidence of effectiveness for these interventions. The results of this review were used to inform the development of a number of resources to aid the planning of healthy pregnancies in both women with SMI and the health professionals working with them.
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O'Connor, Daniel W., David M. Clarke, and Ian Presnell. "How is Psychiatry Taught to Australian and New Zealand Medical Students?" Australian & New Zealand Journal of Psychiatry 33, no. 1 (February 1999): 47–52. http://dx.doi.org/10.1046/j.1440-1614.1999.00512.x.
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Objective: This study aimed to describe the amount, format and content of psychiatry teaching programs in all 12 Australian and New Zealand medical schools. Method: A structured questionnaire which included definitions and coding instructions was completed by class coordinators for the years of 1995 or 1996. Missing and inconsistent data were checked by coordinators and results were confirmed by heads of department. Results: Most departments of psychiatry taught throughout the undergraduate course. Only three made no contribution to pre-clinical teaching. The time devoted to clinical tuition ranged from 279 to 454 h per university with a mean of 353 h. Clinical attachments occupied most time (mean = 70%), followed by small group teaching (mean = 19%) and lectures (mean = 11%). Medical schools varied greatly in the attention given to history taking and mental state examination, psychological therapies and the sub-specialties of child and aged psychiatry. Clinical attachments were mostly to adult inpatient units. Private psychiatric hospitals and clinics were used infrequently as were consultation-liaison psychiatry services and primary care. Conclusion: There is a need to broaden the clinical experience of students to better equip them for future medical practice. There appears to be a serious mis-match between the settings in which most students are taught and the settings in which most will work later as non-psychiatric practitioners. It was disappointing that psychological therapies received so little attention given the central place of counselling in modern medical practice.
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Jorm, Anthony F., Stephen J. Rosenman, and Patricia A. Jacomb. "Inequalities in the Regional Distribution of Private Psychiatric Services Provided under Medicare." Australian & New Zealand Journal of Psychiatry 27, no. 4 (December 1993): 630–37. http://dx.doi.org/10.3109/00048679309075826.
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An analysis was carried out on Medicare data to find out if there are inequalities in the geographical distribution of private psychiatric services in Australia. The number of psychiatric services and persons becoming patients per 100,000 population was calculated for each federal electorate for the year 1985/86 and related to social indicators derived from the 1986 census. As a comparison, services provided by consultant physicians were analyzed as well. The data were based on the electorate of the patient rather than the electorate of the practitioner. Consultant psychiatrist services were found to be received more often in high socio-economic status electorates and those with older populations, and less often in rural areas. A similar pattern was found for consultant physician services, although the relationship with socio-economic status was not as strong. Frequent psychiatric consultations of longer duration, which are an indicator of insight psychotherapy, were more common in higher socioeconomic status electorates. A limitation of the Medicare data is that they cover only private services. To overcome this limitation, a supplementary analysis was carried out on the distribution of consultations for mental disorders using data from the National Health Survey. These data confirmed that individuals of high socio-economic status with a mental disorder are more likely to receive specialist treatment.
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Draper, Brian, and Lee-Fay Low. "Psychiatric services for the “old” old." International Psychogeriatrics 22, no. 4 (March 15, 2010): 582–88. http://dx.doi.org/10.1017/s1041610210000293.
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ABSTRACTBackground: Few studies have specifically examined mental health service delivery to persons aged over 84 years, often described as the “old” old. Our aim was to compare mental health service provision in Australia to persons aged 85 years and over with the “young” old and other age groups. We hypothesized that the “old” old would differ from the “young” old (65–84 years) by diagnostic category, rates of specialist psychiatric hospital admission, and use of Medicare funded psychiatric consultations in the community.Methods: Mental health service delivery data for 2001–02 to 2005–06 was obtained from Medicare Australia on consultant psychiatrist office-based, home visit and private hospital services subsidized by the national healthcare program and the National Hospital Morbidity database for separations (admitted episodes of patient care) from all public and most private hospitals in Australia on measures of age, gender, psychiatric diagnosis, location and type of psychiatric care.Results: Use of specialist psychiatric services in the community per annum per 1000 persons declined with age in men and women from 137.28 and 191.87 respectively in those aged 20–64 years to 11.84 and 14.76 respectively in those over 84 years. However, men and women over 84 years received psychiatric home visits at 377% and 472% respectively of the rates of persons under 65. The annual hospital separation rate per 1000 persons for specialist psychiatric care was lowest in those aged over 84 (3.98) but for inpatient non-specialized psychiatric care was highest in those over 84 (21.20). Depression was the most common diagnosis in specialized psychiatric hospitalization in those aged over 84 while organic disorders predominated in non-specialized care in each age group over 64 years with the highest rates in those aged over 84.Conclusion: Mental health service delivery to persons aged over 84 is distinctly different to that provided to other aged groups being largely provided in non-specialist hospital and residential settings.
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Smith, Graeme Crawford, David Murray Clarke, and Helen Edith Herrman. "Consultation-liaison psychiatry in Australia." General Hospital Psychiatry 15, no. 2 (March 1993): 121–24. http://dx.doi.org/10.1016/0163-8343(93)90108-z.
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Lakra, V. "Telehealth in Australia." European Psychiatry 65, S1 (June 2022): S569. http://dx.doi.org/10.1192/j.eurpsy.2022.1457.
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Introduction There is a significant psychiatry workforce shortage in Australia, particularly in rural and remote communities. Given the large distances involved, telehealth – providing consultation via videoconference – has been widely accepted. Psychiatrists were among the highest users of telehealth services in Australia before the COVID-19 pandemic. However, the outbreak of COVID-19 resulted in a major transformation to service delivery across Australia. Private psychiatrists and state public mental health services had to rapidly transition to largely telehealth delivery to ensure continuity of care for consumers. In March 2020, additional telehealth item numbers were added to the Australian Medicare Benefits Schedule (MBS) to encourage physical distancing for those accessing medical services during the pandemic. Objectives To provide an overview of the increase in telehealth activity since the COVID-19 pandemic. Methods The MBS is the list of services for which the Australian Government will pay a rebate. Key data on MBS telehealth activity since March 2020 was examined. Results The use of telehealth has increased during the pandemic. A survey of Royal Australian and New College of Psychiatrists (RANZCP) psychiatrists found that 93% supported retention of telehealth MBS item number numbers following the COVID-19 pandemic, noting increased accessibility for consumers. Positive feedback has been received from consumers. Conclusions During 2020 and 2021, the RANZCP worked with the Australian Government to ensure there were appropriate MBS telehealth services available for consumers. The RANZCP continues to work with the Government as they plan for a longer-term transformation of telehealth services beyond 2021. Disclosure No significant relationships.
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Jorm, A. F., and A. S. Henderson. "Use of Private Psychiatric Services in Australia: An Analysis of Medicare Data." Australian & New Zealand Journal of Psychiatry 23, no. 4 (December 1989): 461–68. http://dx.doi.org/10.3109/00048678909062613.
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An analysis of Medicare data for the 1985–86 financial year showed that the distribution of private psychiatric services varied greatly by age and sex. Females were greater users than males, except in childhood where the opposite was true. Service use was lowest for children and for the elderly and highest for the 35–44 year old group. Amongst patients receiving psychiatric services, elderly people were more likely to receive short consultations and ECT. These findings carry considerable implications for health service policy and for medical education.
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Phillips, Nicole, and Lorraine Dennerstein. "The Psychiatrist in an Obstetric/Gynaecology Hospital: Establishing a Consultation-Liaison Service." Australian & New Zealand Journal of Psychiatry 27, no. 3 (September 1993): 464–71. http://dx.doi.org/10.3109/00048679309075804.
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The establishment and first six months of a psychiatric consultation-liaison service to an Australian obstetric and gynaecology hospital is described. Referrals, diagnoses and follow-up of patients are discussed, with case reports used to illustrate the types of patients seen. Evaluation of the findings and Dossible future directions for the service are discussed.
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Looi, Jeffrey CL, and William Pring. "To tele- or not to telehealth? Ongoing COVID-19 challenges for private psychiatry in Australia." Australasian Psychiatry 28, no. 5 (August 26, 2020): 511–13. http://dx.doi.org/10.1177/1039856220950081.
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Objectives: Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate. Conclusions: Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.
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Mudiyanselage, Irangani, and Madhvi Belgamwar. "A study to improve the quality of writing clinic letters to patients attending the outpatient clinic." BJPsych Open 7, S1 (June 2021): S211. http://dx.doi.org/10.1192/bjo.2021.565.
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AimsIn many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters. However, experience suggests that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams. (Rayner et al, BMJ 2020)The aim of the study was to obtain patient's views to improve the quality of clinical letters sent to them, hence the level of communication and standards of care.MethodAn anonymous questionnaire was designed and posted to collect information from patients attending one of the South County Mental Health outpatient clinic in Derbyshire. 50 random patients were selected between March to November 2020. Patients were asked to provide suggestions to improve the quality of their clinic letters written directly to them and copies sent to their GPs.ResultOut of 50 patients 48% (n = 24) responded. Majority of patients (92%) expressed their wish to receive their clinic letters written directly to them and 79% preferred to be addressed as a second person in the letters. More than half (54%, N = 13) of them would like to have letter by post. Majority of them (92%, N = 22) wished to have their letter within a week of their consultations.Patients attending clinics felt that the communication could be better improved through writing clearly: a) reflection of what was discussed during the consultation b) updated diagnosis c) a clear follow-up plan d) current level of support e) medication change f) emergency contact numbers g) actions to be carried out by their GP and further referrals should there be any.ConclusionPatients in community prefer to have their clinic letters directly addressing them in second person. It was noted that the letters needed to reflect accurately on what was discussed during the consultation in order to have patient centered consultations. This in turn would improve communication and thus rapport, trust and overall therapeutic relationship.
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Lee, Wei, Michelle DiGiacomo, Brian Draper, Meera R. Agar, and David C. Currow. "A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying." Journal of Palliative Care 37, no. 4 (September 9, 2022): 535–44. http://dx.doi.org/10.1177/08258597221121453.
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Objective: To ascertain palliative physicians’ and consultation-liaison psychiatrists’ perceptions of depression care processes in patients with very poor prognoses, exploring key challenges and postulating solutions. Methods: A qualitative focus group study involving three 1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted between November-December 2020. Fellows and trainees were recruited from Australian and New Zealand Society of Palliative Medicine (n = 11) and Royal Australian and New Zealand College of Psychiatrists (n = 4). Data underwent conventional qualitative content analysis. Results: Participants perceived depression care to be complex and challenging. Perceived barriers included: inadequate palliative care psychiatry skills with variation in clinical approaches; lack of supportive health infrastructure (poor access to required interventions and suboptimal linkage between palliative care and psychiatry); lack of research support; and societal stigma. Suggested solutions included integrating care processes between palliative care and psychiatry to improve clinician training, establish supportive health systems and promote innovative research designs. Conclusions: Developing clinician training, supportive health systems and innovative research strategies centering on integrating palliative care and psychiatry care processes may be integral to optimising depression care when providing care to people with very poor prognoses.
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Happell, Brenda, and Julie Sharrock. "EVALUATING THE ROLE OF A PSYCHIATRIC CONSULTATION-LIAISON NURSE IN THE AUSTRALIAN GENERAL HOSPITAL." Issues in Mental Health Nursing 23, no. 1 (January 2002): 43–60. http://dx.doi.org/10.1080/01612840252825473.
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Emmerson, Brett, Aaron Frost, Jacinta Powell, Warren Ward, Mark Barnes, and Rowena Frank. "Evaluating a GP Consultative Psychiatric Service in an Australian Metropolitan Hospital District." Australasian Psychiatry 11, no. 2 (June 2003): 195–98. http://dx.doi.org/10.1046/j.1039-8562.2003.00547.x.
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Objective: The aim was to develop a psychiatric assessment and advisory service for local general practitioners (GPs). Method: In July 2001, five full-time psychiatrists at Royal Brisbane Hospital each dedicated a 1-h appointment per week in their hospital private practice clinic to assess patients referred by local GPs. The ‘Psych Opinion’ clinic was advertised through the Division of General Practice Newsletter. After 12 months, the referrals to the clinic had been disappointing so two surveys were carried out: one to the GPs who had used the service and the other to those who had not referred. Results: Feedback from the GPs who had used the service showed a high level of satisfaction with the service. The second survey of the GPs who had not referred showed a strong endorsement of the concept but there was poor awareness of the service's existence. Conclusions: This model offers a way for public sector psychiatrists to provide timely assessments to local GPs without additional funding. There is strong support and willingness from the GPs to refer. However, the need to actively market the service both initially and on an ongoing basis is highlighted.
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Looi, Jeffrey CL, and William Pring. "Private metropolitan telepsychiatry in Australia during Covid-19: current practice and future developments." Australasian Psychiatry 28, no. 5 (June 2, 2020): 508–10. http://dx.doi.org/10.1177/1039856220930675.
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Objective: This paper discusses issues arising from the rapid implementation of metropolitan telepsychiatry in private practice during the Covid-19 public health emergency. Conclusions: The relatively rapid uptake of private practice metropolitan telepsychiatry may further increase flexibility of the options for appointments through ongoing broad telepsychiatry access after the Covid-19 crisis. Telepsychiatry can be used to facilitate the temporary provision of psychiatric care, and has benefits and risks, but is not a longer-term replacement for the interpersonal richness of face-to-face consultations.
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Palmer, Susan, Pandora Patterson, and Kate Thompson. "A national approach to improving adolescent and young adult (AYA) oncology psychosocial care: The development of AYA-specific psychosocial assessment and care tools." Palliative and Supportive Care 12, no. 3 (May 10, 2013): 183–88. http://dx.doi.org/10.1017/s1478951512001083.
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AbstractObjective:Age-based screening tools and assessment measures are crucial to the provision of best practice care for adolescent and young adult (AYA) cancer patients. Unfortunately, there are limited psychosocial tools developed for this age group and pediatric or adult measures are often distributed with the assumption that they are “close enough.” We describe a collaborative Australian project that strives to improve what currently exists for the psychosocial assessment of and planning for the 15–25-year-old age group.Method:Using the National Comprehensive Cancer Network's Distress Thermometer and the HEADSS Assessment as a foundation, the tools were developed in consultation with Australia's leading AYA clinicians, AYAs currently undergoing medical treatment, and a group of AYA survivors through a process of discussion groups and clinical interviews.Results:The result is the first available AYA-specific screening tool, care plan pro forma, and psychosocial assessment measure developed for use within the oncology sector. These new tools will assist clinicians working with this population group to support psychosocial coping during active treatment and promote healthy post-treatment survivorship.Significance of results:Over time, further validation procedures will add to the veracity of the measures. Until then, these measures represent the best available in Australia. They highlight a clinically recognized minimum standard of care that all young cancer patients, regardless of treatment location, have the right to receive.
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Giles, S., S. Sreedharan, and M. Mian. "Mental health attendances in Australia during the COVID-19 pandemic: A telehealth success story?" European Psychiatry 64, S1 (April 2021): S698. http://dx.doi.org/10.1192/j.eurpsy.2021.1848.
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IntroductionThe COVID-19 pandemic has significantly impacted the delivery of mental health services globally. Within Australia, the COVID-19 pandemic and subsequent containment measures have led to reduced face-to-face attendances. To maintain access to mental health consultations, new telehealth services were introduced by the Australian Government in late March 2020.ObjectivesWe aimed to quantify the impact of the COVID-19 pandemic on patterns of mental health attendances in Australia using an interrupted time series model.MethodsTo characterise patterns of mental health service utilisation, monthly mental health attendances between January 2016 and June 2020 were extracted from the Medicare database, stratified by clinician type: general practitioner (GP), psychiatrist, and allied health. We used triple exponential smoothing to model attendances between January 2017 and December 2019. Observed and predicted attendances between January and June 2020 were compared with 95% confidence (p<0.05).Results Our models showed decreased mental health attendances in March and April, consistent with all healthcare services during this time. While uptake of telehealth was significant, it only partially covered the reduction in mental health attendances.Conclusions Our modelling highlights the significant impacts of the COVID-19 pandemic on mental health services in Australia, with telehealth only partially compensating for the reduction in face-to-face attendances. These results suggest that telehealth services may not be suitable for all individuals (e.g. those without reliable internet access). Given that telehealth will likely remain a feature of mental health service provision, outreach and face-to-face services should be considered for vulnerable groupsDisclosureNo significant relationships.
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Smith, Anthony C., Nigel R. Armfield, Jasmine Croll, and Leonard C. Gray. "A review of Medicare expenditure in Australia for psychiatric consultations delivered in person and via videoconference." Journal of Telemedicine and Telecare 18, no. 3 (February 23, 2012): 169–71. http://dx.doi.org/10.1258/jtt.2012.sft111.
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Sharrock, J., and B. Happell. "An overview of the role and functions of a psychiatric consultation liaison nurse: an Australian perspective." Journal of Psychiatric and Mental Health Nursing 8, no. 5 (October 2001): 411–17. http://dx.doi.org/10.1046/j.1365-2850.2001.00415.x.
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Smith, Graeme C., Peter M. Ellis, Vaughan J. Carr, Warwick K. Ashley, Helen M. Chesterman, Brian Kelly, Paul W. Skerritt, and Murray Wright. "Staffing and Funding of Consultationliaison Psychiatry Services in Australia and New Zealand." Australian & New Zealand Journal of Psychiatry 28, no. 3 (September 1994): 398–404. http://dx.doi.org/10.3109/00048679409075865.
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The aim of the study was to establish the current and desired levels of staffing and funding of the 52 consultation-liaison (C-L) psychiatry training units in Australian and New Zealand general hospitals. Administration of a questionnaire and follow-up verification provided data on referral rates, existing and preferred staffing levels, and staff workloads. The referral rates and staffing levels in most cases fall below those quoted for Europe and the USA, and those considered optimal by the respondents. This, together with the large variation in referral rates and workload, has implications for the type of clinical activity conducted and quality of the training experience in different units.
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Black, Christopher M., Michael Woodward, Baishali M. Ambegaonkar, Alana Philips, James Pike, Eddie Jones, Joseph Husbands, and Rezaul K. Khandker. "Quantifying the diagnostic pathway for patients with cognitive impairment: real-world data from Australia." International Psychogeriatrics 32, no. 5 (November 25, 2019): 601–10. http://dx.doi.org/10.1017/s1041610219001856.
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ABSTRACTObjectives:Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.Design:A real-world, cross-sectional survey of physicians and patients.Setting:Clinical practice.Participants:Primary care or specialist physicians managing patients with cognitive impairment (CI).Measurements:Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.Results:Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.Conclusions:A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.
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Leggett, Andrew. "Transcultural issues in the dynamics of a Balint clinical reflection group for community mental health workers." Transcultural Psychiatry 49, no. 2 (January 5, 2012): 366–76. http://dx.doi.org/10.1177/1363461511432494.
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The author presents transcultural issues in the content, process, and group dynamics of consecutive meetings of a Balint clinical reflection group for community mental health workers at Inala, Australia. Balint work and the context and evolution of the group process are briefly described, as is the consultative research methodology. The process of a Balint group meeting is reported in detail, following the author’s consultation with group members. The collaborative work of a culturally diverse team of mental health professionals is examined in the context of discussion of a practitioner–patient relationship in which transcultural, gender, and family conflicts were the focus of affective and cognitive dissonance. For mental health workers engaging with communities of cultural diversity, Balint reflection groups can facilitate insight into cultural countertransferences that adversely affect clinical work. The group served to support the caseworkers’ engagement with patients of different cultures, and provided a safe environment for the creative consideration and exploration in fantasy of the emotional pressures and complex ethical dilemmas related to boundaries in transcultural client–practitioner relationships, including those in which open discussion would otherwise be avoided.
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Andrews, Gavin, and Dusan Hadzi-Pavlovic. "The Work of Australian Psychatrists, Circa 1986." Australian & New Zealand Journal of Psychiatry 22, no. 2 (June 1988): 153–65. http://dx.doi.org/10.3109/00048678809158955.
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A random sample of psychiatrists was asked to supply details about their last 20 patients. Sixty percent responded. The median patient in treatment was aged 36 and saw a psychiatrist in office practice once a month over a three year period. Forty-one percent of the patient case load suffered from a psychotic disorder, 39% from a neurosis, and 6% from a personality disorder. Marital problems, problems in living and drug or alcohol dependence were infrequent reasons for consultation. Two positive conclusions were drawn: that the case load reflected the morbidity in the community, and that the prognosis for patients with personality disorders was better than usually expected. There were two areas of concern that may need attention: that insight and group psychotherapy require substantial numbers of treatment hours, and that behavioural psychotherapy is rarely used for patients whith neurotic conditions.
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Northam, Jaimie Chloe, and Lynne Magor-Blatch. "Developing a standard for youth modified therapeutic communities." Therapeutic Communities: The International Journal of Therapeutic Communities 37, no. 3 (September 12, 2016): 140–48. http://dx.doi.org/10.1108/tc-01-2016-0004.
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Purpose The purpose of this paper is to explore the applicability of the Australasian Therapeutic Communities Association (ATCA) Standard to Australian youth-specific modified therapeutic communities (MTCs). An Interpretive Guide for Youth MTCs and Residential Rehabilitation (RR) Services was developed and a pilot trial conducted with three Australian youth MTC services. Design/methodology/approach Using a mixed-methods design, this study included three components: a consultation process with residential youth MTCs (N=15), which informed the development of the ATCA Standard Interpretive Guide for Youth MTCs and RR Services; a pilot trial of the materials with three Australian youth MTCs (N=53); and an evaluation of the interpretive guide and assessment of applicability of the ATCA standard to youth MTCs through pre- (N=32) and post- (N=19) pilot trial administrations of the Survey of Essential Elements Questionnaires (SEEQ), and post-pilot trial focus groups (N=21). Findings Results indicate that the ATCA Standard is applicable to youth MTC settings when applied with the Interpretive Guide, although no significant differences were found between the pre- and post-pilot trial administrations of the SEEQ. Practical implications Future research is recommended to explore active mechanisms of youth-specific MTCs, differences between adults and youth MTCs, and the development of TC-specific training. Originality/value To date, no standard for youth residential substance use services in Australia has been developed, and this is the first study of its kind internationally to explore the efficacy of standards in a youth MTC.
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Fehily, Caitlin MC, Kate M. Bartlem, John H. Wiggers, Paula M. Wye, Richard V. Clancy, David J. Castle, Andrew Wilson, et al. "Effectiveness of embedding a specialist preventive care clinician in a community mental health service in increasing preventive care provision: A randomised controlled trial." Australian & New Zealand Journal of Psychiatry 54, no. 6 (May 14, 2020): 620–32. http://dx.doi.org/10.1177/0004867420914741.
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Objective: Clinical practice guidelines recommend that community mental health services provide preventive care for clients’ chronic disease risk behaviours; however, such care is often not routinely provided. This study aimed to assess the effectiveness of offering clients an additional consultation with a specialist clinician embedded within a community mental health service, in increasing client-reported receipt of, and satisfaction with, preventive care. Method: A randomised controlled trial was undertaken in one Australian community mental health service. Participants ( N = 811) were randomised to receive usual care (preventive care in routine consultations; n = 405) or usual care plus the offer of an additional consultation with a specialist preventive care clinician ( n = 406). Blinded interviewers assessed at baseline and 1-month follow-up the client-reported receipt of preventive care (assessment, advice and referral) for four key risk behaviours individually (smoking, poor nutrition, alcohol overconsumption and physical inactivity) and all applicable risks combined, acceptance of referrals and satisfaction with preventive care received. Results: Analyses indicated significantly greater increases in 12 of the 18 preventive care delivery outcomes in the intervention compared to the usual care condition from baseline to follow-up, including assessment for all risks combined (risk ratio = 4.00; 95% confidence interval = [1.57, 10.22]), advice for all applicable risks combined (risk ratio = 2.40; 95% confidence interval = [1.89, 6.47]) and offer of referral to applicable telephone services combined (risk ratio = 20.13; 95% confidence interval = [2.56, 158.04]). For each component of care, there was a significant intervention effect for at least one of the individual risk behaviours. Participants reported high levels of satisfaction with preventive care received, ranging from 77% (assessment) to 87% (referral), with no significant differences between conditions. Conclusion: The intervention had a significant effect on the provision of the majority of recommended elements of preventive care. Further research is needed to maximise its impact, including identifying strategies to increase client uptake.
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Smith, Graeme C., David M. Clarke, and Helen E. Herrman. "Establishing a consultation-liaison psychiatry clinical database in an Australian general hospital." General Hospital Psychiatry 15, no. 4 (July 1993): 243–53. http://dx.doi.org/10.1016/0163-8343(93)90039-q.
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Harris, M. G., A. J. Baxter, N. Reavley, S. Diminic, J. Pirkis, and H. A. Whiteford. "Gender-related patterns and determinants of recent help-seeking for past-year affective, anxiety and substance use disorders: findings from a national epidemiological survey." Epidemiology and Psychiatric Sciences 25, no. 6 (October 2, 2015): 548–61. http://dx.doi.org/10.1017/s2045796015000876.
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Aims.To examine: (1) gender-specific determinants of help-seeking for mental health, including health professional consultation and the use of non-clinical support services and self-management strategies (SS/SM) and; (2) gender differences among individuals with unmet perceived need for care.Method.Analyses focused on 689 males and 1075 females aged 16–85 years who met ICD-10 criteria for a past-year affective, anxiety or substance use disorder in an Australian community-representative survey. Two classifications of help-seeking for mental health in the previous year were created: (1) no health professional consultation or SS/SM, or health professional consultation, or SS/SM only, and; (2) no general practitioner (GP) or mental health professional consultation, or GP only consultation, or mental health professional consultation. Between- and within-gender help-seeking patterns were explored using multinomial logistic regression models. Characteristics of males and females with unmet perceived need for care were compared using chi-square tests.Results.Males with mental or substance use disorders had relatively lower odds than females of any health professional consultation (adjusted odds ratio [AOR] = 0.46), use of SS/SM only (AOR = 0.59), and GP only consultation (AOR = 0.29). Notably, males with severe disorders had substantially lower odds than females of any health professional consultation (AOR = 0.29) and GP only consultation (AOR = 0.14). Most correlates of help-seeking were need-related. Many applied to both genders (e.g., severity, disability, psychiatric comorbidity), although some were male-specific (e.g., past-year reaction to a traumatic event) or female-specific (e.g., past-year affective disorder). Certain enabling and predisposing factors increased the probability of health professional consultation for both genders (age 30+ years) or for males (unmarried, single parenthood, reliance on government pension). Males with unmet perceived need for care were more likely to have experienced a substance use disorder and to want medicine or tablets or social intervention, whereas their females peers were more likely to have experienced an anxiety disorder and to want counselling or talking therapy. For both genders, attitudinal/knowledge barriers to receiving the types of help wanted (e.g., not knowing where to get help) were more commonly reported than structural barriers (e.g., cost).Conclusions.Findings suggest a need to address barriers to help-seeking in males with severe disorders, and promote GP consultation. Exploring gender-specific attitudinal/knowledge barriers to receiving help, and the types of help wanted, may assist in designing interventions to increase consultation. Mental health promotion/education efforts could incorporate information about the content and benefits of evidence-based treatments and encourage males to participate in other potentially beneficial actions (e.g., physical activity).
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Lee, Yu-Chen, Mary Lou Chatterton, Anne Magnus, Mohammadreza Mohebbi, Long Khanh-Dao Le, and Cathrine Mihalopoulos. "Cost of high prevalence mental disorders: Findings from the 2007 Australian National Survey of Mental Health and Wellbeing." Australian & New Zealand Journal of Psychiatry 51, no. 12 (June 1, 2017): 1198–211. http://dx.doi.org/10.1177/0004867417710730.
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Objective: The aim of this project was to detail the costs associated with the high prevalence mental disorders (depression, anxiety-related and substance use) in Australia, using community-based, nationally representative survey data. Methods: Respondents diagnosed, within the preceding 12 months, with high prevalence mental disorders using the Confidentialised Unit Record Files of the 2007 National Survey of Mental Health and Wellbeing were analysed. The use of healthcare resources (hospitalisations, consultations and medications), productivity loss, income tax loss and welfare benefits were estimated. Unit costs of healthcare services were obtained from the Independent Hospital Pricing Authority, Medicare and Pharmaceutical Benefits Scheme. Labour participation rates and unemployment rates were determined from the National Survey of Mental Health and Wellbeing. Daily wage rates adjusted by age and sex were obtained from Australian Bureau of Statistics and used to estimate productivity losses. Income tax loss was estimated based on the Australian Taxation Office rates. The average cost of commonly received Government welfare benefits adjusted by age was used to estimate welfare payments. All estimates were expressed in 2013–2014 AUD and presented from multiple perspectives including public sector, individuals, private insurers, health sector and societal. Results: The average annual treatment cost for people seeking treatment was AUD660 (public), AUD195 (individual), AUD1058 (private) and AUD845 from the health sector’s perspective. The total annual healthcare cost was estimated at AUD974m, consisting of AUD700m to the public sector, AUD168m to individuals, and AUD107m to the private sector. The total annual productivity loss attributed to the population with high prevalence mental disorders was estimated at AUD11.8b, coupled with the yearly income tax loss at AUD1.23b and welfare payments at AUD12.9b. Conclusion: The population with high prevalence mental disorders not only incurs substantial cost to the Australian healthcare system but also large economic losses to society.
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Sved Williams, Anne, Jane Dodding, Ian Wilson, Jeffrey Fuller, and Victoria Wade. "Consultation-Liaison to General Practitioners Coming of Age: The South Australian Psychiatrists' Experience." Australasian Psychiatry 14, no. 2 (June 2006): 206–11. http://dx.doi.org/10.1080/j.1440-1665.2006.02276.x.
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